Provider Demographics
NPI:1508961103
Name:MURPHY, KATHLEEN MAURA
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MAURA
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:MAURA
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:50 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2401
Mailing Address - Country:US
Mailing Address - Phone:617-349-3937
Mailing Address - Fax:
Practice Address - Street 1:50 PROSPECT ST. C/O CUSTOM-EYES
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-349-3937
Practice Address - Fax:617-349-0074
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1508961103OtherNPI
MAU61901Medicare UPIN
MA1508961103OtherNPI